Thanks in part to the growing prevalence of chronic disease among American adults, more and more commercial health plans are introducing chronic care management programs. However, the effectiveness of these programs has been hindered by limited patient engagement and the reluctance of doctors to change the way they practice.
Optometrists are working more closely with physicians and insurers to identify patients' chronic conditions and make sure those patients receive appropriate medical care. They want to demonstrate that they have the training and skills to do more than just fit people for glasses and contact lenses
A study, published in The American Journal of Managed Care examined the chronic care management programs of 25 health plans with commercial enrollment of 50,000 or more members. The study found similarities in the overall structure of the programs, but differences in the way plans identified members who might need chronic care management, as well as how they matched interventions and resources to patients’ needs and risks.
Nearly half (42%) of the plans studied reported “substantial challenges” to recruiting members to use chronic care management services. Challenges included missing or invalid contact information or members simply not responding to attempts to reach them.
Among the members who do participate in a chronic care management program, the most common problems to improving care are limited patient engagement, health literacy, and patient readiness to change. In response, nearly half of the plans report using some form of incentive—such as gift cared, or lowering cost-sharing requirements or premiums—to get patients more engaged.
Providers cited limited provider staff resources and lack of patient registries and electronic health records as barriers to effective chronic care management. Some providers are also reluctant to change and have hampered efforts at better chronic care management. Thirty-eight percent of the plans said coordination with providers was the most important factor in making chronic care management plans work.
Health plans are using a variety of strategies to strengthen patient and provider engagement and improve the effectiveness of their chronic care management plans. Strategy suggestions include:
- Collaborating more closely with providers by, for example, placing health plan staff members in practices that care for a large number of patients covered by the plan,
- Helping practices redesign payment and delivery systems so that they better serve the needs of chronically ill patients,
- Greater use of patient support technology, such as telemedicine, remote monitoring, and social media applications, and
- Focused interventions, such as the use of predictive modeling to identify patients for disease or case management, or algorithms for predicting high-cost events such as exacerbations and hospital interventions.
As healthcare continues to shift, there is growing emphasis on helping patients with chronic conditions better manage their health. The role of optometrists in primary care and population health will increase. Patients with two or more chronic conditions – such as heart failure, diabetes and asthma – make up more than two-thirds of the entire Medicare population. And caring for these patients requires extra time – something most physicians don’t have. As physicians are looking to bring more personalized care to their practices this group of chronic care patients continue to be a tough group to implement changes and additional services.